The Psychiatric Patient as God, I Guess . . .
Psychiatric patients are incredibly selfish. Yeah yeah, sob sob, boo hoo hoo — yes, we’re sick, we’re a fucking nightmare, but shit: can’t we leave our poor doctors alone?
This opening, certainly related to me, is for my own doctor, an otherwise great guy whose hovering ability to subscribe me medicines has become tertiary to our fifteen minute conversations every six weeks. Today, as I write this, for whatever day this piece might wind up being read, he and I babbled — or I guess I did at least, his sharp sense of humor abiding my bleak self-parody into a sort of narrative joy — the conversations had with this very skilled and genuinely human doctor, it is like that haunting voice in the dark, the mental patient’s sadness and inability to control their bleakest urges, that voice of professional conscience towering in the background as the self-absorbed crazy person rants and rants and rants, and sometimes makes the doctor laugh.
Crazy people like to think about death, their personal involvement dependent upon their upbringing, or their religious doubts and obsessions; their fanaticism and families and bodies and flaws; fucking some terrible person because they want to prove how much they hate themselves, or feeling rejected because their lack of confidence is a major turn off.
Some crazy people see murder, themselves too precious, their religious fixations dependent upon messiah complexes (or so the pharmaceutical companies say, urging the shrug-shouldered doctors — this too is their job, they must endlessly tell themselves.)
Success — personal success illuminates these powerful people, these talented, ambitious half-saints, tolerating the assholes all doctor’s must eventually find many whining pussies to be from time to time to time. So they give us drugs, a variety of moderately effective chemicals they hope won’t kill us, and maybe they’ll keep us quiet for a while, and they hope on rare occasions that even their favored patients might show up and be puffed cloudlessly high:
“Yeah, doc, everythin’s cool. I think I’m doin’ better. I can’t get hard but, you know, I don’t really need to anymore. Can I have my script?”
And an arm scratch, maybe the wiping of a nose, and the patient looks away, ashamed, a condition almost constant to their lives anyway, and the doctor will accommodate you, still professionally competent, only tired, having a life of interest of their own.
Sometimes when we care for patients, for other people in our lives, sometimes we just can’t take them — some of it’s gotta be about you, after all! — and why do we think we can be any better?
We offer aimless solutions, misunderstanding the usually exaggerated crises scattered throughout our lives. We nod our heads rapidly, no longer wanting to hear, no longer involved. And we see the world drifting, see the indifferent nature of human reality, and of death and life and life.
The crazy patient is often well beyond gloom, giddy, a sneering preacher of apocalypse filled with great joy and great venom. They will deny everything, destroy any part of the world, then flutter back to their desolate void, trying to live a life they can never understand.
They will bifurcate reality, break apart the rest of the world into dreams and hopes and themes; into rage, into enmity, into the feeling that outsiders don’t deserve life.
Therein rises conspiracy, and jealous insanity leaving seven people dead from bloody rage . . . but we should leave that to experts, for a monster such as myself, bound to make things worse, is the wrong idea to define tragedy; and we can play true frenzy that hurts, and rearranges the dangerous things outside of ourselves. It is a jigsaw of endless possibility
But this too is for the experts, and not just the lifelong student, studying behavior, recognizing the sidesteps and explosions within every plea for mercy or cry for help.
Doctors often underestimate their patients. Some patients are much sharper at their doctor’s job than even the smartest therapist might be. Sometimes the treatment is mutual.
And so the doctor and patient memorialize; they make declarations of pride and truth and resolution, and they shake their heads with mutual understanding, misunderstanding it all from every side, and then the two of them split apart and go home into their individual worlds, from that same place where people seek out help, and where a few compassionate, surely experienced souls offer their lives to the souls of others.
I want to thank every doctor I have ever had in my life, even the worthless, useless dope peddlers holding their scripts above me, perhaps waiting for a blow job until the clock for the next appointment rings. To those inept students turned merely target practice, and to those talented young futurists I was so impressed with I could only sit shyly with my crush.
There is a question as to whether any of these people ever did me any good, or anybody else (although quite a few have actually at least pretended to listen, a hope for human contact reserved in advance that I suspect without any interest the appointment becomes a clinical nightmare.) It is difficult to say — surely some of them did not — and yet the rest proved themselves human, actual struggling people torn by their careers and the everyday everyday in and outside of work, all those forlorn fantasies and obnoxious rage. Perhaps it can be a real treat for the doctor (we tell ourselves) and patient (as we know) to find each other in a mutual moment in the middle of a stressful day, and you can exhale honestly, both of you, realizing that everything is tolerable and there is no censorship in life.
The process of endless therapy, off and on, has changed the very light of the world for me. This is not a positive phrase, nor a good review, and certainly not some born again epiphany where I finally see the light; this is acknowledgment of the opening of perspectives. Intense psychotherapy and varied drug treatments have given me a view outside myself. It is all a stubborn, atheistic fuck-up like me could pray for.
The psychiatric patient decides that they are God, I guess. The doctor in the room listens to blathering, obsessive rants and must play acolyte or debunk their character’s set until they decide to change. The struggle will shortly end in exhaustion or tears, in begging for desperate help. It is all part of the human game we play with each other, no matter our audience.
Being a terminal patient, being diagnostically, psychiatrically, and self-aware of sickness, this too offers freedom. There is freedom to insanity. There is endless time to juggle irrational thoughts, and to consider other crazy options, and the hopelessness applied to ever getting better can make your life a rise and fall drama, the sort of existence that at the end of days we all wish we could see flashing before our eyes